En bloc transurethral resection of bladder tumors: A review of current techniques

Abstract

Introduction: Growing interest surrounds the concept of en bloc transurethral resection of bladder tumors (ERBT). Theoretical advantages include improved adherence to oncological principles and potential yield of superior pathological specimens. Multiple ERBT methods exist. This review summarizes the current evidence regarding application of differing techniques and technologies to ERBT. Methods: A systematic review of MEDLINE/EMBASE/Scopus databases was performed, using terms “en bloc,” “ERBT,” “bladder,” and “urinary bladder neoplasm.” Template-based data extraction included technique of ERBT, feasibility, tumor size, activation of obturator nerve reflex, operative complications, detrusor muscle sampling rate, and recurrence data. Results: Multiple approaches to ERBT have evolved, using a variety of energy sources. The feasibility of electrocautery, laser, combined waterjet/electrocautery, and polypectomy snare techniques have been confirmed in achieving ERBT. ERBT appears safe, with a low complication rate. The use of laser energy sources reduces the risk of activating the obturator nerve reflex during lateral wall resections. Otherwise, no energy source is unequivocally superior in achieving ERBT. The rate of detrusor muscle sampling is high with use of ERBT and appears superior to that achieved with conventional TURBT (cTURBT) in multiple comparative studies. A limited number of largely non-randomized trials assess bladder tumor recurrence; current evidence suggests this is similar between ERBT and cTURBT groups. Conclusions: En bloc resection of bladder tumors using a variety of technologies is feasible and safe, with a high detrusor muscle sampling rate. Further research is required to determine whether rates of residual disease or recurrence can be reduced with ERBT vs. cTURBT.

Transurethral en bloc resection of a bladder perivascular epithelioid cell tumor (PEComa): a case report

“…In addition, this is also the rst case in which a complete tumor specimen was obtained through the urethra. Previous literature has reported that ERBT has the advantages of a lower surgical complication rate and higher quality of tumor specimens compared to conventional TURBT in bladder urothelial tumor surgery [18,19]. We believe that for non-muscle invasive bladder PEComa, especially solitary, with pedicle, narrow-basal, small-sized tumor, ERBT is a good surgical approach to resect the tumor to maintain tumor integrity, reduce intraoperative bleeding, and minimize tissue remnants.…”

A Systematic Review on the Role of Repeat Transurethral Resection after Initial en Bloc Resection for Non-Muscle Invasive Bladder Cancer

“…Recently, ERBT has emerged as an alternative to cTURB [ 42 ]. In contrast to ‘piecemeal’ resection by cTURB, ERBT incorporates a more delicate en bloc sculpting and tumor excision [ 43 ]. ERBT appears safe, feasible, and effective with demonstrably higher rates of DM in the pathologic specimen and provides better staging [ 6 ].…”

En-bloc Laser Resection of Bladder Tumors: Where Are We Now?

“…Transurethral resection of bladder tumors (TURBT) is a crucial procedure in the management of bladder cancer. The goals of TURBT are to make the correct diagnosis, sample the detrusor muscle for staging, and completely remove all visible lesions [ 1 , 2 , 3 , 4 , 5 ]. The quality of the resection strongly influences patient prognosis and overall treatment success.…”

“…Although it is still the gold standard, conventional TURBT using the incision and scatter technique has a number of potential drawbacks. For example, thermal damage to nearby tissue can lead to difficulty in the pathological evaluation of fragmented tissue, and tumor fragmentation with a high number of exfoliated cancer cells could lead to infield and outfield recurrences [ 1 , 2 , 3 , 4 , 5 ].…”

“…Tumor selection criteria are still unconfirmed. Although it is estimated that ERBT is not feasible for almost 30% of tumors due to size, morphology, and/or location, laser ERBT has been performed for tumors up to 4.5–5.5 cm in diameter and in virtually all locations throughout the bladder [ 3 , 4 ].…”